Provider Demographics
NPI:1770677254
Name:MCQUAIN, JERRY ALAN (MPT DO)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ALAN
Last Name:MCQUAIN
Suffix:
Gender:M
Credentials:MPT DO
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:ALAN
Other - Last Name:MCQUAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT, DO
Mailing Address - Street 1:4043 NORTHRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-612-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204139207RH0002X, 207R00000X
CO0053205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine